Factors associated with positive D-dimer results in patients evaluated for pulmonary embolism

Christopher Kabrhel, D. Mark Courtney, Carlos A. Camargo, Michael C. Plewa, Kristen E. Nordenholz, Christopher L. Moore, Peter B. Richman, Howard A. Smithline, Daren Beam, Jeffrey Kline

Research output: Contribution to journalArticle

61 Citations (Scopus)

Abstract

Objectives: Available D-dimer assays have low specificity and may increase radiographic testing for pulmonary embolism (PE). To help clinicians better target testing, this study sought to quantify the effect of risk factors for a positive quantitative D-dimer in patients evaluated for PE. Methods: This was a prospective, multicenter, observational study. Emergency department (ED) patients evaluated for PE with a quantitative D-dimer were eligible for inclusion. The main outcome of interest was a positive D-dimer. Odds ratio (ORs) and 95% confidence intervals (CIs) were determined by multivariable logistic regression. Adjusted estimates of relative risk were also calculated. Results: A total of 4,346 patients had D-dimer testing, of whom 2,930 (67%) were women. A total of 2,500 (57%) were white, 1,474 (34%) were black or African American, 238 (6%) were Hispanic, and 144 (3%) were of other race or ethnicity. The mean (±SD) age was 48 (±17) years. Overall, 1,903 (44%) D-dimers were positive. Model fit was adequate (c-statistic = 0.739, Hosmer and Lemeshow p-value = 0.13). Significant positive predictors of D-dimer positive included female sex; increasing age; black (vs. white) race; cocaine use; general, limb, or neurologic immobility; hemoptysis; hemodialysis; active malignancy; rheumatoid arthritis; lupus; sickle cell disease; prior venous thromboembolism (VTE; not under treatment); pregnancy and postpartum state; and abdominal, chest, orthopedic, or other surgery. Warfarin use was protective. In contrast, several variables known to be associated with PE were not associated with positive D-dimer results: body mass index (BMI), estrogen use, family history of PE, (inactive) malignancy, thrombophilia, trauma within 4 weeks, travel, and prior VTE (under treatment). Conclusions: Many factors are associated with a positive D-dimer test. The effect of these factors on the usefulness of the test should be considered prior to ordering a D-dimer.

Original languageEnglish (US)
Pages (from-to)589-597
Number of pages9
JournalAcademic Emergency Medicine
Volume17
Issue number6
DOIs
StatePublished - 2010
Externally publishedYes

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Pulmonary Embolism
fibrin fragment D
Thrombophilia
Hemoptysis
Venous Thromboembolism
Sickle Cell Anemia
Warfarin
Cocaine
Hispanic Americans
African Americans
Postpartum Period
Nervous System
Multicenter Studies
Observational Studies
Orthopedics
Renal Dialysis
Hospital Emergency Service
Rheumatoid Arthritis
Neoplasms
Estrogens

Keywords

  • D-dimer
  • Pulmonary embolism
  • Testing
  • Venous thromboembolism

ASJC Scopus subject areas

  • Emergency Medicine
  • Medicine(all)

Cite this

Factors associated with positive D-dimer results in patients evaluated for pulmonary embolism. / Kabrhel, Christopher; Courtney, D. Mark; Camargo, Carlos A.; Plewa, Michael C.; Nordenholz, Kristen E.; Moore, Christopher L.; Richman, Peter B.; Smithline, Howard A.; Beam, Daren; Kline, Jeffrey.

In: Academic Emergency Medicine, Vol. 17, No. 6, 2010, p. 589-597.

Research output: Contribution to journalArticle

Kabrhel, C, Courtney, DM, Camargo, CA, Plewa, MC, Nordenholz, KE, Moore, CL, Richman, PB, Smithline, HA, Beam, D & Kline, J 2010, 'Factors associated with positive D-dimer results in patients evaluated for pulmonary embolism', Academic Emergency Medicine, vol. 17, no. 6, pp. 589-597. https://doi.org/10.1111/j.1553-2712.2010.00765.x
Kabrhel, Christopher ; Courtney, D. Mark ; Camargo, Carlos A. ; Plewa, Michael C. ; Nordenholz, Kristen E. ; Moore, Christopher L. ; Richman, Peter B. ; Smithline, Howard A. ; Beam, Daren ; Kline, Jeffrey. / Factors associated with positive D-dimer results in patients evaluated for pulmonary embolism. In: Academic Emergency Medicine. 2010 ; Vol. 17, No. 6. pp. 589-597.
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abstract = "Objectives: Available D-dimer assays have low specificity and may increase radiographic testing for pulmonary embolism (PE). To help clinicians better target testing, this study sought to quantify the effect of risk factors for a positive quantitative D-dimer in patients evaluated for PE. Methods: This was a prospective, multicenter, observational study. Emergency department (ED) patients evaluated for PE with a quantitative D-dimer were eligible for inclusion. The main outcome of interest was a positive D-dimer. Odds ratio (ORs) and 95{\%} confidence intervals (CIs) were determined by multivariable logistic regression. Adjusted estimates of relative risk were also calculated. Results: A total of 4,346 patients had D-dimer testing, of whom 2,930 (67{\%}) were women. A total of 2,500 (57{\%}) were white, 1,474 (34{\%}) were black or African American, 238 (6{\%}) were Hispanic, and 144 (3{\%}) were of other race or ethnicity. The mean (±SD) age was 48 (±17) years. Overall, 1,903 (44{\%}) D-dimers were positive. Model fit was adequate (c-statistic = 0.739, Hosmer and Lemeshow p-value = 0.13). Significant positive predictors of D-dimer positive included female sex; increasing age; black (vs. white) race; cocaine use; general, limb, or neurologic immobility; hemoptysis; hemodialysis; active malignancy; rheumatoid arthritis; lupus; sickle cell disease; prior venous thromboembolism (VTE; not under treatment); pregnancy and postpartum state; and abdominal, chest, orthopedic, or other surgery. Warfarin use was protective. In contrast, several variables known to be associated with PE were not associated with positive D-dimer results: body mass index (BMI), estrogen use, family history of PE, (inactive) malignancy, thrombophilia, trauma within 4 weeks, travel, and prior VTE (under treatment). Conclusions: Many factors are associated with a positive D-dimer test. The effect of these factors on the usefulness of the test should be considered prior to ordering a D-dimer.",
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AU - Moore, Christopher L.

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AU - Smithline, Howard A.

AU - Beam, Daren

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N2 - Objectives: Available D-dimer assays have low specificity and may increase radiographic testing for pulmonary embolism (PE). To help clinicians better target testing, this study sought to quantify the effect of risk factors for a positive quantitative D-dimer in patients evaluated for PE. Methods: This was a prospective, multicenter, observational study. Emergency department (ED) patients evaluated for PE with a quantitative D-dimer were eligible for inclusion. The main outcome of interest was a positive D-dimer. Odds ratio (ORs) and 95% confidence intervals (CIs) were determined by multivariable logistic regression. Adjusted estimates of relative risk were also calculated. Results: A total of 4,346 patients had D-dimer testing, of whom 2,930 (67%) were women. A total of 2,500 (57%) were white, 1,474 (34%) were black or African American, 238 (6%) were Hispanic, and 144 (3%) were of other race or ethnicity. The mean (±SD) age was 48 (±17) years. Overall, 1,903 (44%) D-dimers were positive. Model fit was adequate (c-statistic = 0.739, Hosmer and Lemeshow p-value = 0.13). Significant positive predictors of D-dimer positive included female sex; increasing age; black (vs. white) race; cocaine use; general, limb, or neurologic immobility; hemoptysis; hemodialysis; active malignancy; rheumatoid arthritis; lupus; sickle cell disease; prior venous thromboembolism (VTE; not under treatment); pregnancy and postpartum state; and abdominal, chest, orthopedic, or other surgery. Warfarin use was protective. In contrast, several variables known to be associated with PE were not associated with positive D-dimer results: body mass index (BMI), estrogen use, family history of PE, (inactive) malignancy, thrombophilia, trauma within 4 weeks, travel, and prior VTE (under treatment). Conclusions: Many factors are associated with a positive D-dimer test. The effect of these factors on the usefulness of the test should be considered prior to ordering a D-dimer.

AB - Objectives: Available D-dimer assays have low specificity and may increase radiographic testing for pulmonary embolism (PE). To help clinicians better target testing, this study sought to quantify the effect of risk factors for a positive quantitative D-dimer in patients evaluated for PE. Methods: This was a prospective, multicenter, observational study. Emergency department (ED) patients evaluated for PE with a quantitative D-dimer were eligible for inclusion. The main outcome of interest was a positive D-dimer. Odds ratio (ORs) and 95% confidence intervals (CIs) were determined by multivariable logistic regression. Adjusted estimates of relative risk were also calculated. Results: A total of 4,346 patients had D-dimer testing, of whom 2,930 (67%) were women. A total of 2,500 (57%) were white, 1,474 (34%) were black or African American, 238 (6%) were Hispanic, and 144 (3%) were of other race or ethnicity. The mean (±SD) age was 48 (±17) years. Overall, 1,903 (44%) D-dimers were positive. Model fit was adequate (c-statistic = 0.739, Hosmer and Lemeshow p-value = 0.13). Significant positive predictors of D-dimer positive included female sex; increasing age; black (vs. white) race; cocaine use; general, limb, or neurologic immobility; hemoptysis; hemodialysis; active malignancy; rheumatoid arthritis; lupus; sickle cell disease; prior venous thromboembolism (VTE; not under treatment); pregnancy and postpartum state; and abdominal, chest, orthopedic, or other surgery. Warfarin use was protective. In contrast, several variables known to be associated with PE were not associated with positive D-dimer results: body mass index (BMI), estrogen use, family history of PE, (inactive) malignancy, thrombophilia, trauma within 4 weeks, travel, and prior VTE (under treatment). Conclusions: Many factors are associated with a positive D-dimer test. The effect of these factors on the usefulness of the test should be considered prior to ordering a D-dimer.

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